The Indications and Limitations of Heart-CT

Dr. Jess Lambrechtsen says more patients can benefit from Heart-CT, including those with unstable heart rate or reduced renal function. But patient selection is still crucial.

Jess Lambrechtsen, MD-PhD, Lead Clinician at the Department of Internal Medicine at Svendborg Hospital

With more than 5,000 Heart-CT analyses and descriptions on his resumé, Jess Lambrechtsen MD-PhD, Lead Clinician at the Department of Internal Medicine at Svendborg Hospital in Denmark, has a firm grip on the indications and limitations of this method.

“Current guidelines indicate heart-CT for patients with a low to intermediary risk (15-50 %) of coronary heart disease. Now, with better equipment and more training, that indication can be extended to more patients.”

While patients with severely reduced renal function or unstable heart rate are still excluded from a heart-CT examination, recent technological advances have pushed back on some of these limitations.

“Some of the newer machines can cover the entire heart (16 cm) in one rotation, where they previously required five rotations. This highly reduces artefacts, and it allows physicians to scan patients with a less steady heart rate.”

“Another improvement we have seen lately is that the scanner requires less contrast agent.”

That means Heart-CT is also becoming a possibility for patients with reduced kidney function,” explains Dr. Lambrechtsen.

He says knowing which patients to select for Heart-CT is key to obtaining the best images.

“Heart-CT can provide an accurate morphological image of the coronary anatomy that no other tool can. It’s an excellent triage tool. If the images show no sign of heart disease, there is no reason to believe otherwise.”

“So this technique is the best choice whenever heart disease has to be ruled out. The exam can also help you assess whether invasive procedures are needed – but it’s important to know the limitations of this method.”

“You get the best images with the right patient selection and patient preparation,” says Dr. Lambrechtsen.